Current Clinical Challenges in the Prevention and Management of COVID-19
Authors: Christine Laine, Deborah Cotton
Journal: Annals of Internal Medicine (2022)

Special Articles9 September 2022Current Clinical Challenges in the Prevention and Management of COVID-19FREEChristine Laine, MD, MPH and Deborah Cotton, MD, MPHChristine Laine, MD, MPHEditor in Chief, Annals of Internal Medicine (C.L.) and Deborah Cotton, MD, MPHDeputy Editor, Annals of Internal Medicine (D.C.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-2684 Eligible for CME Point-of-CareCME/MOC SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail As we approach the last quarter of 2022, it is unfortunate that we must continue to wrestle with COVID-19. We have learned much since SARS-CoV-2 emerged late in 2019, but many uncertainties remain and new questions arise continuously. On 7 September 2022, Annals of Internal Medicine and the American College of Physicians gathered an esteemed group of infectious disease physicians to discuss some of the current clinical challenges: Dr. Sabrina A. Assoumou (Louis W. Sullivan, MD, Professor of Medicine and Assistant Professor of Medicine at Boston University School of Medicine), Dr. Carlos del Rio (Distinguished Professor of Medicine in the Division of Infectious Diseases at Emory University School of Medicine and Executive Associate Dean for Emory at Grady Memorial Hospital), and Dr. Camille N. Kotton (Clinical Director of the Transplant Infectious Disease and Immunocompromised Host Program at the Massachusetts General Hospital, and Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts). Dr. George M. Abraham, ACP's past President and Chief of Medicine at Saint Vincent Hospital in Worcester, Massachusetts, and Professor of Medicine at the University of Massachusetts Medical School, moderated the program. All of these individuals have been and continue to be leaders "on the mat" in this wrestling match with the virus—caring for patients, conducting research, participating in policy development, serving on the Centers for Disease Control and Prevention's (CDC) immunization committee (Dr. Kotton), and helping to disseminate trustworthy, current COVID-19 information.The program began with presentation of 3 clinical vignettes. After polling the participants about what they would do in each scenario, the panelists shared their own approaches. The panelists then addressed specific questions submitted by attendees during the program as well as when they had registered for it. Only days before the program, the U.S. Food and Drug Administration (FDA) and CDC released decisions regarding the approval of and clinical indications for bivalent vaccines active against both the ancestral strain of SARS-CoV-2 and the BA.4 and BA.5 strains currently circulating. Thus, it was no surprise that the appropriate use of these vaccines was a major topic of discussion: When will they be available? Who should get them? When is the best time to administer them? What is the appropriate regimen for people who have not yet received initial vaccination? Are they likely to benefit vaccinated people who have also had acute infections? A very important point noted during the program is that the bivalent vaccines should not be administered until after a person receives initial vaccination with a monovalent vaccine. The panelists also provided guidance on the best use of pharmacologic therapies based on a balance of available evidence and practical realities. In response to a specific question about why professional organizations discourage interventions such as ivermectin and hydroxychloroquine, the panelists emphasized the need to focus on interventions that we know are beneficial rather than those that have not shown benefit in high-quality studies. They noted that inequitable availability of both preventive and therapeutic interventions within the United States and globally contributes to the difficulty in controlling this pandemic. Video of this program and the 9 previous ones are available at Annals.org (www.acpjournals.org/journal/aim/forums).Video. ACP/Annals COVID-19 Forum X: Current Clinical Challenges in COVID-19 Prevention and Management The ACP/Annals COVID-19 Forum X, held on 7 September 2022, features speakers Carlos del Rio, MD; Sabrina A. Assoumou, MD, MPH; Camille N. Kotton, MD; and George M. Abraham, MD, MPH. (Duration 1:09:19)Panelists pointed the audience to a wealth of information about the bivalent vaccines available in slides and video from the 1 September 2022 meeting of the CDC's Advisory Committee on Immunization Practices (1), which are available here: www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-09-01/09-COVID-Hall-508.pdf.In closing, Dr. Abraham posed a question from the audience: "When will the pandemic end?" Drs. Assoumou, del Rio, and Kotton all agreed that this virus is unlikely to disappear. However, they also agreed that we will be able to knock it down from pandemic status if we use the public health and pharmacologic tools available to prevent infection, to reduce poor outcomes of acute COVID-19 when infection does occur, and to end inequities in access to these therapies.Reference1. September 1, 2022 ACIP Meeting - Welcome & Coronavirus Disease 2019 (COVID-19) Vaccines. Centers for Disease Control and Prevention YouTube page. 7 September 2022. Accessed at https://youtube.com/watch?v=_SgTNFlQlqg on 9 September 2022. Google Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Editor in Chief, Annals of Internal Medicine (C.L.)Deputy Editor, Annals of Internal Medicine (D.C.)Disclosures: All relevant financial relationships have been mitigated. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-2684.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Christina C. Wee, MD, MPH, Senior Deputy Editor, reports employment with Beth Israel Deaconess Medical Center and consultancy with Boston Medical Center. Stephanie Chang, MD, MPH, Deputy Editor, reports employment with the Agency for Healthcare Research and Quality, travel compensation from the Guidelines International Network, and participation in the Patient-Centered Outcomes Research Institute methodology committee. Vineet Chopra, MD, MSc, Deputy Editor, reports grants received from the Agency for Healthcare Research and Quality and royalties from UpToDate and Oxford University Press. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interests to disclose. Eliseo Guallar, MD, MPH, DrPH, Deputy Editor, Statistics, reports that he is employed at Johns Hopkins University. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports employment with the Perelman School of Medicine, University of Pennsylvania, and consultancies with the U.S. Food and Drug Administration and the State of Colorado.Corresponding Author: Christine Laine, MD, MPH, Editor in Chief, Annals of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, [email protected]org.This article was published at Annals.org on 9 September 2022. Nextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCOVID-19 Vaccine: What Physicians Need to Know Christine Laine , Deborah Cotton , and Darilyn V. Moyer COVID-19 Vaccine: Promoting Vaccine Acceptance Christine Laine , Deborah Cotton , and Darilyn V. Moyer COVID-19 Vaccine Distribution and Allocation: What Physicians Need to Know Christine Laine , Deborah Cotton , and Darilyn V. Moyer COVID-19 Vaccine: Practical Clinical Considerations Christine Laine , Deborah Cotton , and Darilyn V. 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